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STUDY DESIGN A retrospective study. OBJECTIVE To report the incremental hospital resources consumed with treating adverse events experienced by Medicare beneficiaries undergoing a two or three vertebrae level cervical spinal fusion. SUMMARY OF BACKGROUND DATA Hospitals are increasingly at financial risk for patients experiencing adverse events due "pay for performance." Little is known about incremental resources consumed when treating patients who experienced an adverse event after cervical spinal fusions. METHODS Fiscal years 2013 and 2014 Medicare Provider Analysis and Review file was used to identify 86,265 beneficiaries who underwent 2 or 3 vertebrae level cervical spinal fusion. International Classification of Diseases 9th Clinical Modification diagnostic and procedure codes were used to identify 10 adverse events. This study estimated both the observed and risk-adjusted incremental hospital resources consumed (cost [2014 US $] and length-of-stay) in treating beneficiaries experiencing each adverse event. RESULTS Overall, 6.2% of beneficiaries undergoing cervical spinal fusion experienced at least one of the study's adverse events. Beneficiaries experiencing any complication consumed significantly more hospital resources (incremental cost of $28,638) and had longer length-of-stay (incremental stays of 9.1 days). After adjusting for patient demographics and comorbid conditions, incremental cost of treating adverse events ranged from $42,358 (infection) to $10,100 (dural tear). CONCLUSION Adverse events frequently occur and add substantially to the hospital costs of patients undergoing cervical spinal fusion. Shared decision-making instruments should clearly provide these risk estimates to the patient before surgical consideration. Investment in activities that have been shown to reduce specific adverse events is warranted, and this study may allow health systems to prioritize performance improvement areas. LEVEL OF EVIDENCE 3.

Study Design. This study analyzed the use of the one piece cervical device (OPCD) surgically inserted to treat atlanto-axial or subaxial subluxation. Operative results, techniques, and the enhanced correction mechanism were studied. Objectives. The results were correlated to provide a rationale for posterior cervical spinal fusion. Summary of Background Data. Wiring techniques were generally performed for posterior fusion. Recently, the Luque rod has been used on the cervical spine. Methods. One hundred eighty-seven patients were analyzed clinically and radiologically. The operative techniques were detailed and the corrective mechanism explained through biomechanical considerations. Results. The patients were followed from 2 to 13 years. The results were 94% satisfactory. No poor or worsening cases were encountered. Conclusions. Satisfactory operative results showed that the OPCD is safe, convenient, and reliable. It can be used in all areas of the cervical spine. The primary reason for these benefits is the enhanced correction mechanism of the OPCD.